My Experience Correcting a Class I Crowded Malocclusion

My Experience Correcting a Class I Crowded Malocclusion: A Damon Ultima PSL Case Study by Dr. Michael Bicknell

I recently had the opportunity to treat a 48-year-old female patient with a Class I crowded malocclusion using the Damon Ultima PSL System. In this blog post, I will walk you through the details of the case, including the patient’s initial presentation, treatment objectives, and the phases of treatment. I will also share the lessons I learned and reflect on the efficiency of using the Damon UltimaTM PSL System for this case.

Case Treatment Presentations

Before Treatment

During Treatment

After Treatment

Patient Presentation and Treatment Objectives

The patient exhibited a Class 1 crowded malocclusion, featuring moderate crowding in both the upper and lower jaws. She had a convex facial profile with a slightly retrusive mandible. This was due to a vertical mandibular pattern. Additionally, her smile esthetics were compromised due to a constricted arch form with tapered buccal segments, resulting in poor smile width and dark buccal corridors.

The treatment objectives were to create space. Maintain the position of the maxillary incisors. To improve the smile arc by erupting the incisors. And to develop the posterior segments to increase arch length and smile width. It was crucial to resolve crowding through arch development while maintaining proper torque control to avoid further lip strain. The plan chosen included non-extraction, the Damon Ultima PSL System, along with light vertical elastics. The goal was to achieve early overbite correction and smile arc improvement.

Treatment Phases and Observations

Phase 1: During the initial phase, we started with 0.013 CuNiTi U/L wires and used early part-time elastics.  We used 2 oz. 3/16 Class 1 triangles from the upper U3’s to the lower L3-4’s. This approach aimed to assist the eruption of the maxillary incisors and address overbite issues. Over the course of eight months, we progressed through various wire changes, including 0.014 CuNiTi and 0.018 CuNiTi, extending to the U/L7’s. At the end of phase 1, most rotations were corrected, arch development was progressing well, and the crowding had been resolved.

Phase 2: In this phase, we transitioned to 0.018 x 0.0275 CuNiTi Ultima U/L wires. We made adjustments, such as lacing the upper 3-3 to avoid space opening, changing the elastics to Class 2 full-time, and repositioning a few brackets. The U/L3’s were also selected for proclined torque to improve angulation. Notably, archform significantly improved in both shape and width, and torque changes closely aligned with the final goals.

Phase 3: For the finish, the wires used were stainless steel (SS) Ultima 0.018 x 0.0275 for the upper arch and SS Ultima 0.016 x 0.0275 for the lower arch. Every four weeks the patient was seen for wire shaping and instructions on Class 2 box elastics to aid right side closure. The finishing phase was straightforward, requiring minimal adjustments, thanks to early resolution of rotations and axial inclination, as well as torque expression through the Ultima wire range.

Lessons Learned and Case Overview

Reflecting on this case, I identified the importance of proper selection of variable torque on the U/L3’s to achieve efficiency in reaching the final position. Given that this case was part of the Ultima Study, the patient was seen on four-week intervals. However, if treated outside of this protocol, we could have maintained the 0.013 CuNiTi wire for eight weeks and progressed directly to 0.018 CuNiTi and then to 0.014 x 0.0275, simplifying phase 1.

Overall, the Damon Ultima PSL System with variable torques proved effective in correcting the malocclusion, resolving crowding, and achieving significant arch development. The patient demonstrated exceptional compliance with elastics throughout the treatment journey. From a clinical efficiency standpoint, the case was completed in 13 months with only 11 treatment visits.

In Conclusion, treating this Class I crowded malocclusion using the Damon Ultima PSL System was a rewarding experience. The successful resolution of crowding, improvement in smile esthetics, and maintenance of maxillary incisor position validated the treatment objectives. I am grateful for the valuable lessons learned from this case, which will undoubtedly enhance my future orthodontic practice

Written by Dr. Michael Bicknell, DDS, MS

Dr. Michael Bicknell, DDS, MS, earned his DDS and completed a residency in orthodontics at the University of Illinois at Chicago College of Dentistry where he also received a MS in oral biology. He is a former clinical instructor at the university and continues his involvement there by lecturing to dental students and orthodontic residents throughout the year. In private practice in Elmhurst, Ill., he is a diplomate of the American Board of Orthodontics and is an internationally recognized educator, presenting to thousands of orthodontists on subjects such as efficient treatment, esthetics, leadership and creating a culture of excellence.

Bicknell is a Damon System Mentor. He is a paid consultant for Ormco. The opinions expressed are those of Bicknell. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgement in treating their patients. Teeth images have not been altered. Patient results may vary.

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